Provider Demographics
NPI:1528000643
Name:FAKHOURY, ROMMIE FAWZI (MD)
Entity Type:Individual
Prefix:
First Name:ROMMIE
Middle Name:FAWZI
Last Name:FAKHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 872
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701
Mailing Address - Country:US
Mailing Address - Phone:909-989-7100
Mailing Address - Fax:909-989-6333
Practice Address - Street 1:10601 CHURCH STREET STE 110
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-989-7100
Practice Address - Fax:909-989-6333
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine